Provider Demographics
NPI:1386622058
Name:DU, DIANE D (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:D
Last Name:DU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:DE-YI
Other - Last Name:DU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1900 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1724
Mailing Address - Country:US
Mailing Address - Phone:516-542-1090
Mailing Address - Fax:770-666-9097
Practice Address - Street 1:1000 TENTH AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-4332
Practice Address - Fax:212-523-4829
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191279207ZP0101X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY220031046OtherMEDICARE RAILROAD
NY5099653OtherGHI
NYA400062374OtherNGS
NY1Y0802OtherBLUE CROSS
NYA400062374OtherNGS
NY904662T131Medicare PIN
NY5099653OtherGHI